Foodborne transmission of hepatitis A--Massachusetts, 2001.

Hepatitis A virus (HAV) is transmitted typically from person to person by the fecal-oral route. Foodborne transmission occurs when an HAV-infected food handler contaminates food during preparation or when food is contaminated during harvesting or processing before reaching the food service establishment or home. Postexposure prophylaxis (PEP) with immune globulin (IG) can prevent hepatitis A among exposed persons if administered within 14 days of exposure. However, the decision about whether to implement PEP for persons who eat food prepared by an infected food handler depends on an assessment of the duties performed by the food handler and personal hygiene while potentially infectious, which are often difficult to determine. This report summarizes the investigation of an outbreak of foodborne hepatitis A in Massachusetts in which a food handler with hepatitis A, who was considered unlikely to transmit HAV, was implicated as the source. The findings underscore challenges faced by local and state health departments when determining whether PEP is appropriate.